Individual
MRS. JEANETTA SHEPPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
301 ANDREWS AVENUE, UNITED STATES ARMY SUBSTANCE ABUSE PROGRAM, FORT RUCKER, AL 36362-5105
(334) 255-7918
(334) 255-7617
Mailing address
301 ANDREWS AVE., FORT RUCKER, AL 36362-5105
(334) 255-7918
(334) 255-7617
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CAP867
FL
101YA0400X
Addiction (Substance Use Disorder) Counselor
ICADC6435
FL
1041C0700X
Clinical Social Worker
Primary
2027C
AL
1041C0700X
Clinical Social Worker
SW7254
FL
Other
Enumeration date
02/21/2006
Last updated
06/18/2012
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